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Tennessee rates for HCPCS L4045

Replace nonmolded thigh lacer, for custom fabricated orthosis only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$166.26 / $166.26 / $181.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.18 / $171.51 / $311.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.19 / $332.60 / $332.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$197.54 / $230.92 / $230.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.57 / $168.57 / $230.92
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$622.11 / $1,940.98 / $2,340.52
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,973.74 / $3,045.11 / $3,045.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.91 / $180.52 / $277.45